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Mindscape Education (Pty) Ltd Olivedale Business Park  

35 Lima Rd, Olivedale  2188 

www.mindscapeeducation.co.za   

Registration: 2015/03508/087 

GRADE 10 - GRADE 12 REGISTRATION FORM ‐ 2022 

Thank you for choosing Mindscape Education as your preferred curriculum provider.

 Kindly complete the document as follows – Incomplete applications will not be processed.

Once this application document has been completed, please email your application and supporting documents to 

registration@mindscapeeducation.co.za 

Document Checklist 

⃣⃣⃣⃣⃣⃣⃣

⃣

Complete and signed registration forms. Copy of the Parent's/Guardian's ID (first time applicants only). Copy of the Account Holder's ID (if different from Parent/Guardian). Copy of the Child's Birth Certificate or ID (first time applicants only). Most recent report showing progression to the next grade (Term 3 reports will not be accepted) NB: Grade 11 learners must provide a Grade 10 report. NB: Grade 12 learners must provide a Grade 10 & 11 report (required by UMALUSI and SACAI) by 30 December to progress to Grade 12 Proof of concessions if applicable or application submitted before 28 February.

Once you have received a quote or invoice, kindly make payment to the bank details stipulated on your invoice and use the learners Name and Surname or the account number as a reference. Proof of payments can be emailed to accounts@mindscapeeducation.co.za

Use Black Ink Only

•Sign the document in full on the lastpage

Initial All 

Pages

Mindscape Curriculum 

box is dispatched. 

Deposit or full payment is 

made to Mindscape 

Application is processed 

and  invoiceis issued 

Scan and email or 

complete on online 

Complete application and attach supporting documents 

REGISTRATION FORM - 2022PLEASE COMPLETE WITH A BLACK PENDO YOU HAVE ANY LEARNERS CURRENTLY REGISTERED WITH MINDSCAPE? Yes No

Parent to Student : Yes / No Tutor to Student : Yes / No

LEARNER INFORMATIONLEARNER INFORMATIONLEARNER

Full names:

Surname:

Preferred name:

Date of birth:

ID number:

Nationality: RSA Other

Religious denomination:

Gender: Male Female

Ethnic group:

Home language:

Learner's language preference:

Learner mobile number:

Learner e-mail address:

Admission date:

Grade in 2022 :

Years in grade for 2022 :

Years in phase for 2022 :

Pre-primary education attended: Formal Informal

Other: _____________

Attach learner photo:

Method of transport:

Taxi/Bus registration number:

Name of driver:

Contact number:

NEXT OF KIN INFORMATION

Name:

Contact number:

Alternative contact number:

Relation:

OFFICE USE ONLY

Family code:

Register class:

SBA Venue:

Waiting list: A B

Number on waiting list:

Parent ID copy: Deposit fee: Most recent report: Birth certificate / ID:

FAMILY INFORMATION

Family status: Both parents Single parent - Unmarried

Foster care Childrens home Single parent - Divorced

Other Re-composed Widow/Widower

Parents deceased: Mother Father None

LEARNER HEALTH INFORMATION

Chronic diseases

or allergies :

Concession App:

MEDICAL AID INFORMATION

Name:

Telephone number:

Member number:

Primary member:

FAMILY DOCTOR INFORMATION

Name:

Telephone number:

Business address:

INFORMATION OF PREVIOUS SCHOOL/PLAY GROUP/NURSERY

First registration of learner in Gauteng: Yes No

Learner attended school last year Yes No

If yes, in which Province/Country:

Previous school

Telephone Number

Address

Province

Highest grade in previous school

Reason for leaving the school

(ddmmyyyy)

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BIOLOGICAL PARENT / LEGAL GUARDIAN 1 INFORMATION

SMS E-mail

Title:

Full names:

Surname:

Initials:

Preferred name:

ID number:

Home language:

Communication preference:

Language preference: N/A

Mobile number:

Home tel:

Fax:

E-mail:

Residential address:

Postal address:

Occupation status: Own Employer Professional

Own Employer Non-Professional

House wife Part time

Contract worker Pensioner

Student Temporary

Full time Unemployed

Occupation:

Employer:

Work telephone number:

Employer physical address:

Is the learner living with this parent? Yes No

BIOLOGICAL PARENT / LEGAL GUARDIAN 2 INFORMATION

Title:

Full names:

Surname:

Initials:

Preferred name:

ID number:

Home language:

Communication preference: SMS E-mail

Language preference:

Mobile number:

Home tel:

Fax:

E-mail:

Residential address:

Postal address:

Occupation status: Own Employer Professional

Own Employer Non-Professional

House wife Part time

Contract worker Pensioner

Student Temporary

Full time Unemployed

Occupation:

Employer:

Work telephone number:

Employer physical address:

Is the learner living with this parent? Yes No

ACCOUNTABLE PERSONS INFORMATIONORMATIONATION

BIOLOGICAL PARENT 1 YES / NO

BIOLOGICAL PARENT 2 YES / NO

IF OTHER, PLEASE PROVIDE DETAILS : _________________________________________________________________________

Date of birth: (ddmmyyyy) ____________________________________

Date of birth: (ddmmyyyy) ____________________________________

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2022 PAYMENT OPTIONS - Select by tick

HADEDA Early Bird Promotion! valid until 30 November 2021. Payment in full to qualify for 2021 fees.

Option 1 Full Annual Fee upfront payment @ 7.5% discount - valid until 31 January 2022

Option 2 40% Deposit on registration and balance paid over 4 termly invoices payable by EFT.

**Termly payments dates : 12 Jan , 5 April, 19 July and 11 October

Option 3 40% Deposit on registration and balance paid over 10 monthly debit orders.

**Monthly payment dates : 1 Feb, 1 March,1 April, 1 May, 1 June, 1 July, 1 August, 1 Sep, 1 Oct, 1 Nov.

• No Cheques or Cash accepted. Cash paid into the Mindscape Education's account will carry a surcharge• Payments to be paid directly to Mindscape Education and no other third party• Student’s Name and Surname or Invoice number must be used as reference on all payments.• Statements are available via the D6 Connect app. Please download this from the App store or Google Play• Fees quoted are inclusive of VAT.• Debit order forms to accompany the registration form.• Grade 12 Fees include the SACAI National Senior Certificate Exam Fee.• Deposit is payable within 7 days of receipt of invoice• Cancelled or Returned Debit Orders will incur a R250 penalty fee per transaction• All fees are billed per term in advance• Excludes : Courier costs• Excludes : Grade 12 Practical Fees• Excludes : Grade 12 NSC venue hosting fee – where candidate will be hosted for exams.

PAYMENT METHODS Deposit payable upfront in full upon approval of enrolment by EFT

Termly payments via EFT in advance

Monthly payments via Debit Order in advance and subject to approval

I acknowledge and understand the fee structure and payment terms and that a deposit is required if I have chosen the payment plan of Option 2 or 3.

In the event that I need clarification on the fee structure I will contact Mindscape Education directly on 011 704 0687 or email accounts@mindscapeeducation.co.za

South African Comprehensive Assessment Institute (SACAI) fees are subject to change.*R7920 - SACAI National Senior Certificate Fee, included above.**R4200 - SACAI Learner Placement fee, not included above, payable to SACAI in August for venue placement in Nov.

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Who will be responsible for the learners daily teaching?

Pare

nt

to s

tud

en

t • Parent accepts fullresponsibility forchild's education

and facilitatesMindscape Curriculum

Tuto

r to

Stu

de

nt o SBA Venue

o Tutoro Independent School

Name: of Institution

_________________ _________________ _________________ _________________

Delivery Method – please select

Maths Buddy Annual License Mindscape recommends the use of Maths Buddy as an added maths supplement to the day to day teaching. It allows a learner to use the program at home and revise on topics covered in class and incorporates fun online tests for practice and revision. Please note a tablet / computer and internet is required to run the program.

Features over 1 800 animated and narrated (full audio-visual) maths lessons and more than 65 000 interactive questions. Content reflects CAPS curriculumIncludes Advanced Programme Maths (AP Maths)

1 Licence gives you access to content and worksheets for Grade R to Grade 12

ADD R450 per year to my account for my child’s annual license to Maths Buddy 2022

Please note the Math Buddy program is available in English only and is not for Math Literacy learners.

SBA Venue delivery, is a once off annual fee of R350, payable upon registration

Home Delivery, as a once off payment of R450, outlying area may incur additional fee

Collection of your curriculum box from Mindscape H/O in Randburg upon notification.

Maths Buddy Annual License

Subject Based Assessment Venues

Mindscape Education has established SBA Venues across the country where all learners can be hosted for formal assessments. These venues have competent markers and invigilators to facilitate the Mindscape Education assessments in accordance with the Assessment Policy and Procedures.

Please select an SBA Venue of your choice in your area: ______________________________________________

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Important Information!

Please make yourself aware of the following information before registering for Grade 10 – 12.

Conditional approval:

If a final report from the previous grade is not available, an application will be accepted provisionally until a successful and valid final report is submitted to registration@mindscapeeducation.co.za. If the parent/guardian fails to submit a successful and valid final report, the learner’s registration may be cancelled without refund.

Regulations for subject choices:

Please ensure you are aware of the following subject criteria before selecting subjects:

Mathematics and Mathematical Literacy may not be taken together. Learners must select one or the other. Consumer Studies and Hospitality Studies may not be taken together. Learners may select one or the other.

Mathematics is compulsory with Physical Sciences and EGD.

Subject changes:

All subject changes must be approved before an invoice will be sent. For approval, the centre / school HOD is

required to provide a letter of motivation explaining the reason for the subject change. The letter must include:

Learner’s full names and ID number. Approval of any subject change is at Mindscape’s discretion and can be

declined. Subject changes are levied at R320 per change plus the fee of the replacement textbook.

A Grade 10 learner may make a maximum of two subject changes on or before 28 March. A Grade 11 learner may make two subject changes on or before 28 March. No subject changes are allowed in the Grade 12 academic year unless approved through SACAI.

Subjects changes should be carefully considered as the National Senior Certificate is based on knowledge acquired during Grade 10 – 12

Registration and payment cut-off dates:

Grade 12 registrations are concluded by 28 February each year, and no new learners will be accepted after this date.

Grade 10 and 11 registrations during the year - The learner must supply Mindscape with a valid report up to and including the registration date. If no report is available, Mindscape has the right to decline the

learners registrations. All examinations are written according to a set Mindscape / SACAI timetable and no extensions are granted

for any exams missed.

Taking more than seven subjects:

If a learner wants to take more than the required seven subjects, they must complete all the required work, including portfolio work, from Grade 10. The learner must pass each additional subject before they will be allowed to continue with that subject in the next grade.

Concessions:

Application forms for concessions are available on request, however concessions are only considered for Grade 10 – 12 students.

All supporting documents and proof of previous concession/s (if applicable) must be submitted before 31 March.

Applications are approved by SACAI and payable on approval on presentation of invoice.

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Grade and Subject Selection – Complete only the relevant Grade for enrolment

STUDENT NAME & SURNAME: ______________________________________________________________

Grade 10 Grade 11 Grade 12

English Home Language First Additional Language

Afrikaans Home Language First Additional Language

Mathematics • Choose one Maths SubjectMathematical Literacy

Life Orientation

NSC requirements: 4 Compulsory Subjects and 3 elective subjects

Elec

tive

Subj

ects

– C

hoos

e 3

Business Studies

Economics

Accounting

Physical Science • Requires Maths Core

Life Science

Computer Application Technology MS Windows 10 or higher & Office 2019 with Access • Additional NSC Practical Fee of R850(Grade 12 only)

Geography

History

Engineering Graphics and Design • Additional stationery will be required

• Math Core preferable.

Consumer Studies • Cannot be taken with Hospitality Studies

Hospitality Studies • Cannot be taken with Consumer Studies Tourism

Visual Arts • Additional stationery will be required• Additional NSC practical fee of R600

(Grade 12 only)

Design Arts • Additional stationery will be required• Additional NSC practical fee of R600

(Grade 12 only)

Dramatic Art • Additional NSC practical fee of R600(Grade 12 only)

If choosing an 8th subject an additional charge will be applicable.

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STANDARD AGREEMENT

Mindscape Education is hereafter referred to as “Mindscape”.

1. This agreement is applicable to the completeapplication and becomes a binding SLA with theremainder of this application after the signing by the,the Account Holder (if different to the Guardian), theLegal Guardian and Mindscape's representative. Allterms & conditions in the accompanying applicationform and the application for monthly instalment planwill be binding after the signing of the SLA by allrelevant parties.

2. I/We acknowledge and agree that the finalresponsibility for the education and training of my/ourchild(ren) remains with myself/us as parent(s) andthat Mindscape is merely a provider of products &services as an aid to support myself/us in my/oureducation and training responsibilities, and that thisis not an registration at the Department of Education.

3. I/We understand and agree that this SLA mustbe accompanied with a certified copy of theAccount Holder's identity document before anyproduct and/or services will be delivered or rendered.

4. I/We understand and agree that this SLA must beaccompanied with proof of payment of either the fullamount, or the deposit with a signed debit orderinstruction before any product or service will bedelivered or rendered.

5. Furthermore I/We agree to thoroughly check andverify the package received by Mindscapeimmediately on receipt and notify Mindscape within(5) five working days of any variances between thepacking sheet, the contents and the course materialordered. All discrepencies that are reported after the(5) working day period will be at my/our expense, this includes postage, packaging and production costs.

6. I/We acknowledge and agree that Mindscapesproducts & services will remain the property ofMindscape as long as payments are due, andbalances are owing to Mindscape.

7. I/We confirm hereby that I/we take full responsibilityfor the grade choice, subject choices and subjectcombination choices as stated in the LearnerInformation Section(s).

8. With the signing of this SLA I/we undertake to payMindscape according to the agreed contractedamount according to the settlement information asstated above and in accordance with the terms andconditions included in the application for monthlyinstalment plan document that I/we have read,understood and signed.

9. I/We realise and undertake to settle our outstandingbalance by the 1st October each year or as stipulatedon the invoice.

10. I/We understand that a re-enrolment for a new gradeand/or a new student enrolment from the same family will not be considered by Mindscape unless theprevious year's account has been settled in full.

11. II/We agree that Grade 12 Candidate packages willbe purchased by no later than 28th February of the

year of writing Final Examinations and that the account, including examination fees, will be settled in full by no later than the 31st September of the year of writing the Final Examinations.

12. Any subject changes iafter the dispatch of theboxfor Grade 10 - 12 learners, will require thepurchase of the necessary textbooks andprescribed books. I/We agree that the purchase ofthese new books will be at my/our expense being theGuardian/Account Holder's liability.

13. I/We agree that Mindscape may withhold theprovision of tests, examinations and reports if theMindscape account is in arrears.

14. I/We undertake to update Mindscape in writing of any change in my/our contact details, postal and/orresidential address and employment status within(30) thirty days of such occurrence. Should I/we notinform Mindscape of these changes we will not holdMindscape responsible of any form ofcommunication and/or correspondence not receivedand accept the consequences of the breakdown ofcommunication.

15. I/We undertake to adhere to all the relevantsubmission deadlines, portfolio requirements, yearprogramme, scheduled test and examination dates,rules and external moderation minimumrequirements and standards.

16. I/We agree and understand that failure to comply with paragraph 15 above may have a negative impact onmy child/rens academic progress and could result ina grade being repeated.

17. I/We agree that the submission of all documentationwill be at my expense and I will take intoconsideration the required timeframe of postage toensure that all documentation is received byMindscape by the due date.

18. I/We agree to uphold the integrity of Mindscape andthe authenticity of the curriculum and completion ofthe grade by ensuring that all tests, examinations and marking is done honestly, that the invigilation of testsand examinations is in accordance with the rules andguidelines as laid down by Mindscape and UMALUSI and that my child/ren will not have any access to therelevant marking memorandums whatsoever.

19. I/We agree to read all correspondence received fromMindscape thoroughly and take note of any changesof important dates or instructions that may appear inthis correspondence from time to time.

20. I/We hereby acknowledge and accept thatMindscape has a 14 (fourteen) working day windowperiod to dispatch the purchased products from thedate of receipt and acceptance of the requireddocuments, correctly completed application form andproof of payment of either the full amount or theminimum entry fee. Failure to supply any of the above and if the documents are not completed or signedcorrectly will result in a delay in dispatch. Mindscapewill not be held responsible for the delay in the

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learner's/candidate's study program because of an incomplete submission.

21. I/we accept that all national and/or internationaldelivery costs, for whatever reason, includingshipping, postage, packaging, handling and productcost will be for my/our account.

22. All assessment material is the property of MSE and not that of the student or guardian and that thestudent undertakes hereby not to disclose, share,forward, transmit or bring to the any other partyunless a written consent of Mindscape is obtainedand beforehand. Breach of this clause is a materialbreach and will entitle Mindscape to claim damages.

23. I/we hereby declare that we are aware that certainsubjects have additional expenses and productsrequired that are not supplied by Mindscape such ascomputer software, drafting sets, equipment forexperiments/tests that should be performed for thepractical components of certain subjects etc. and that I/we will endeavour to provide these items at my/ourexpense.

24. I/we hereby certify that I/we are aware of anadditional fee of R380 plus courier for the change ofa subject after the 5 (five) day return period ofproducts received.

25. I/we hereby declare that I/we am/are aware thatMindscape and their subject advisors are notresponsible for any additional, extra or remedialclasses. If my/our child(ren) requires any suchadditional help, I/we can request these classes at anadditional fee.

26. I/We accept that we are responsible for the fullamount of the course material as purchased byme/us regardless of cancellation of attendance toany support centre, discontinuation of studies bymy/our child(ren) or for any reason whatsoever.

27. I/We declare that we are aware that the MatricCertificate will be issued by UMALUSI.

28. Mindscape has the right with my/our approval toverify the information entered onto this applicationform including and not limited to, obtaining a creditprofile from any recognised credit bureau, bank orother business institution, and on receipt of negativeinformation has the right to decline the application forpayment terms without prejudice.

thereof will be accepted by me/us without dispute orargument.

29. I/We hereby declare and confirm that I/we am/are not bound by a court order (including administration,sequestration and or liquidation), and that accordingto my/our knowledge no such action is pending soon

30. If the services of a tutor centre or learning academyare enlisted, Mindscape must be informed of suchinstitutions to provide support and after sales serviceto the client. Please see Addendum 2 for completionby the centre.

31. This document embodies the full information andenrolment SLA and the agreement between me/usand Mindscape and any addition or change to this isnull and void, unless the change has been recordedin writing and has been agreed upon and signed byall parties.

32. I/We understand that the responsibility for thecompletion and submission of the Portfolio ofEvidence lies with me/us and I/we will ensure that alldeadlines and requirements are met as laid down bythe SACAI and Mindscape.

33. Should I as a parent wish to enlist the services of atutor centre / teaching institute, I take fullresponsibility of ensuring that the chosen institutionis complying with teaching standards that are in thebest interest of my child/ren

34. I understand that Mindscape does not accreditteaching institutes and has no affiliation with centresbesides for academic support

POPIA COMPLIANCEAs you may be aware the Protection of Personal Information Act (POPIA) came in effect on 1st July 2021.The purpose of the Protection of Personal Information Act, Act No. 4 of 2013 is to protect the personal data of all persons and further outlines how institutions should safeguard, collect, process, store, share and manage this information.

Disclosure of Information:We may disclose your personal information to service providers who are involved in the delivery of products and services to you. We will make every effort to ensure that your permission to disclose your information is obtained prior to disclosing same. Third parties and service providers are obligated, in their own right to ensure that they process your information in accordance with the POPI regulations and protocols. We may also disclose your information where we have a duty to disclose such information in terms of the law.

Information SecurityWe are legally obligated to provide adequate protection for your personal information that we have on record and to prevent unauthorized access and use of same. We will, on an ongoing basis, continue to review our security controls and related processes to ensure that your personal information remains secure.

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Grade 10 – 12 Declaration

I declare that:

I have familiarised myself with the rules regarding admission and subject choices contained in point 10 of this document, (Important Information) and The learner has successfully completed the relevant grade on the CAPS curriculum and the following valid reports are

attached:

• Final Grade 9 report (if enrolling for Grade 10)

• Final Grade 10 report (if enrolling for Grade 11)

• Final Grade 10 and 11 report (if enrolling for Grade 12)

When my final 2021 report is available, I accept the responsibility of submitting it to Mindscape before the end of January 2022. I understand that should I fail to submit a final report, I may be deregistered.

Parent / Account Holder acceptance on contract

ACCOUNT HOLDER:

I, __________________________________________(full names and surname),

(ID number : __________________________________) hereby confirm that I have read and fully understand the above terms and conditions and further that I am personally responsible for the payment of the account or any penalty cost or administration fees, as stipulated above and in the Application Form. I bind myself to these terms and conditions.

Thus done and signed at ____________________ on this ____________ day of ______________ 20___.

Signature:________________________________________________

PARENT / LEGAL GUARDIAN (IF NOT ACCOUNT HOLDER):

I, ___________________________________________ (full names and surname),

(ID number: ____________________________________) hereby confirm that I have read and fully understand the terms and conditions as stipulated above and in the application form. I bind myself to these terms and conditions.

Thus done and signed at ____________________ on this ____________ day of ______________ 20___.

Signature: ________________________________________________